Correlations between balance and ffunctionality, gait speed, physical activity and quality of life in community-dwelling older people

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Physical activity, exercise capacity and mortality risk in people with interstitial lung disease: a systematic review and meta-analysis

Objectives Physical activity and exercise measures show potential to predict mortality in people with interstitial lung disease. This study summarized evidence on the association between physical activity and exercise capacity measures and mortality risk in people with interstitial lung disease and quantified its magnitude by meta-analysis. Design Systematic review and meta-analysis. Methods PubMed, Scopus, Web of Science and EBSCO were searched until May 2020 with updates until September 2021. Two authors screened studies, extracted data, and assessed risk of bias. A random-effects meta-analysis for each physical activity measure was conducted using logarithmic hazard ratios. Results Fifty-two studies of 10,349-people with interstitial lung disease (64 ± 9 years; 67%men) were included. A significant association between at least one measure of physical activity and exercise and mortality risk was found in 44-studies. Most reported measures were the six-minute walk test, oxygen uptake (VO2), work (watts-W) and time spent in physical activity. Meta-analysis showed that individuals with six-minute walk distance < 250 m had more than twofold higher mortality risk, than those with six-minute walk distance ≥ 350 m. Individuals presenting a six-minute walk distance decrease ≥ 26 m over 6–48 months showed an almost threefold higher mortality risk. An increase of 10–20 W or 10 %predicted in workload and a time spent in physical activity ≥ 100 min/week or ≥0.031 kcal/min/kg/day were associated with an overall 12 % and 45 % lower mortality risk, respectively. Conclusions Physical activity and exercise capacity measures were associated with mortality risk in people with interstitial lung disease. Most studies used the six-minute walk test and more evidence is needed on the other measures (i.e., VO2, work and physical activity time). Personalized interventions to improve physical activity and exercise capacity should be considered to delay premature mortality in people with interstitial lung disease.publishe

Cognitive function and lung function, respiratory muscle strength and upper limb functionality in people with dementia

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Relationship between upper limb functional ability and respiratory function in people with dementia

Background: People with dementia often experience lower respiratory tract infections. It is also known that people with dementia present decreased functionality, namely in upper limbs. These two facts lead to higher level of functional dependence and institutionalisation in people with dementia. It is likely that impaired upper limb functional ability affects respiratory function but this association in people with dementia is unknown. Aim: To explore the relationship between upper limb functional ability, lung function and respiratory muscle strength in people with dementia. Methods: An exploratory cross-sectional study was conducted. People with dementia were recruited in nursing homes, day care centres, long-term care facilities and in the community. Upper limb functional ability (Grocery Shelving Task [GST]), lung function (Peak Expiratory Flow [PEF]) and respiratory muscle strength (Maximal Inspiratory/Expiratory [MIP/MEP] and sniff nasal inspiratory [SNIP] pressures) were recorded. Descriptive statistics was used to characterise the sample. Correlations were explored with the Pearson’s correlation coefficient. Results: Fifty people with dementia [75.9±5.9 years old; 35 (70%) female; Body Mass Index=26.6±3.9 kg/m2] participated. GST was significantly: i) low and negatively correlated with SNIP (r=-0.49, p=0.002); and ii) moderate and negatively correlated with PEF (r=-0.58, p<0.001), MIP (r=-0.54, p=0.001) and MEP (r=-0.57, p=0.001). Conclusions: Upper limb functional ability correlated significantly with lung function and respiratory muscle strength in people with dementia. Those with lower upper limb functional ability seem to present worst lung function and respiratory muscle strength. Thus, early detection and personalised interventions may prevent clinical and functional decline in this population. Further research on respiratory function and upper limb functional ability is needed to enhance knowledge on dementia managemenpublishe

Respiratory function and upper limb functional ability in people with dementia: a shout for attention

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Balance and healthy aging: a close relationship

Objectives: This study explored the: i) correlations between the Balance Evaluation Systems Test (BESTest) and its short-versions (Mini-BESTest and Brief-BESTest), with functional ability, gait speed, physical activity, and health-related quality of life; ii) ability of the Five Times Sit to Stand (5STS), 10 MeterWalk Test (10MWT), Brief Physical Activity Assessment Tool (BPAAT) and World Health Organization Quality of Life-Bref (WHOQoL-Bref) to identify the prior history of falls in community-dwelling older people. Methods:An exploratory cross-sectionalstudy was conducted with healthy older people living in the community. Balance (BESTest and its short versions), functional ability (5STS), gait speed (10MWT), physical activity (BPAAT), and health-related quality of life (WHOQoL-Bref) were assessed. Spearman correlation coefficient and receiver operating characteristics analysis were calculated. Results: One hundred and eighteen individuals (76[69-83.3] years; n=79, 66.9% female) participated in this study. Correlations between balance and functional ability (-0.61< r < -0.51, p<0.001), gait speed (0.69 < r < 0.78, p<0.001), physical activity (0.39 < r < 0.42, p<0.001) and health-related quality of life (0.28 < r < 0.57, p≤0.002) were identified.The following cutoff points to differentiate between prior history of falls were established: 80.5 points for the BESTest, 16.5 points for the Mini-BESTest and 12.5 points for the Brief-BESTest, 13.5s for the 5STS, 1.2m/s for the 10MWT, 1.5 points for the BPAAT and 14.5/66; 14.5/66; 14/62.5; 15.5/72 points for domains I, II, III and IV, respectively, of the WHOQoL-Bref 0-20/100. Conclusion: The BESTest and its short versions correlated with functional ability, gait speed, physical activity, and health-related quality of life in older people. These outcomes can differentiate prior history of falls in community-dwelling older people.publishe

Physical activity and mortality risk in people with interstitial lung disease: a systematic review and meta-analysis

Introduction: Physical activity (PA) might be a protective factor for mortality in people with interstitial lung disease (ILD), but evidence is widespread in the literature. This study summarises evidence on the association of PA measures and mortality in people with ILD. Methods: PubMed, Scopus, Web of Science and EBSCO databases were searched. Two authors independently selected studies for inclusion, extracted data and assessed risk of bias. A meta-analysis for each PA measure was conducted using inverse variance-weighted averages of logarithmic hazard ratios (HR) in random-effects models. Results: 48 studies were included with data from 8874 people with ILD [mean age:64±9years; 67%men; 83%IPF; mean DLCO:48.2±15.5%predicted]. Studies’ follow-up period ranged from 23days-15.5years. The 3-most reported PA measures associated with mortality risk were six-minute walk test (6MWT) (n=39), oxygen uptake, peak or maximal (n=9) and workload in watts (W) (n=5). 23 studies were included in the meta-analyses. People walking less than 350-meters in 6MWT had more than twofold risk of premature mortality (Figure 1); and those showing an increase of 10% of predicted or between 10-20W in workload showed a 12% lower risk of mortality. Conclusion: PA measures predict risk of mortality in people with ILD and may be useful to guide clinical decision-making.publishe

Minimal clinically important difference for measures of fatigue, cough and sputum

Fatigue, cough and sputum are highly prevalent in patients with chronic obstructive pulmonary disease(COPD). Pulmonary rehabilitation(PR) has shown to be effective in managing these symptoms. However, the interpretation of the magnitude of PR effects is hindered by the lack of cut-off points to identify clinical improvement. This study established minimal clinically important differences(MCIDs) for the checklist of individual strength – fatigue subscale(CIS-20 FS), functional assessment of cancer therapy – fatigue(FACIT-F), Leicester cough questionnaire(LCQ) and cough and sputum assessment questionnaire(CASA-Q), in patients with COPD following PR. All measures were assessed pre/post 12 weeks of PR. MCIDs were calculated using anchor- and distribution-based methods. Global rating of change, COPD assessment test and St. George’s respiratory questionnaire were used as anchors. Pooled values were obtained using Meta XL with a quality effects model weighting 2/3 for anchor and 1/3 for distribution-based methods. 49 patients with COPD (81.6% male, 69.8±7.4 yrs, FEV1 49.4±19.2%predicted) were included. The pooled MCIDs were: 7.3 for the CIS-20 FS, 4.2 for the FACIT-F, 1.3 for the LCQ, 10 for CASA-Q cough symptoms/ impact and sputum symptoms domains and 7.8 for sputum impact(Fig.1). MCIDs found in this study can be used by health professionals to interpret PR effects in relieving fatigue, cough and sputum and guide future interventions.publishe

Adoção do Lean Management : o caso de uma seguradora

Mestrado Bolonha em Gestão e Estratégia IndustrialDado que o setor segurador tem passado por mudanças significativas nos últimos anos, nomeadamente, com o aumento da exigência dos clientes em relação à qualidade dos serviços prestados, o setor tem focado a sua atenção na eficiência operacional. Para isso, as empresas de seguros têm adotado uma abordagem mais holística para fortalecer a sua posição no mercado. Uma destas abordagens corresponde à metodologia do Lean Management. Esta metodologia, através de várias ferramentas e técnicas que lhes são associadas, é capaz de simplificar e otimizar processos, envolver colaboradores e chefias, e aumentar níveis de produtividade, o que, consequentemente, conduz à eficiência operacional desejada. O presente estudo analisa a forma como um programa de Lean Management foi implementado na Seguradora X, mais concretamente, numa equipa de trabalho pertencente ao Departamento Operacional, responsável pela emissão e gestão de apólices. Os principais objetivos do estudo são: entender a motivação que levou à adoção desta filosofia, enumerar as principais dificuldades sentidas durante a adoção, identificar as ferramentas e técnicas Lean utilizadas, assim como identificar os benefícios e resultados do programa de Lean Management ao nível dos processos. Através da análise documental/arquivo e de entrevistas semiestruturadas, a autora concluiu que a adoção do Lean se deu por decisão do Grupo ao qual a Seguradora X pertence, e que a resistência à mudança e o não acreditar na metodologia foram as principais dificuldades sentidas ao longo do programa. As principais ferramentas e técnicas Lean utilizadas foram: SOP, Gestão Visual, CommCell, VoE e o 1-2-1 coaching. Por fim, o programa trouxe transparência na comunicação, nos processos, e na produtividade da equipa Y.Given that the insurance industry has undergone significant changes in recent years, notably with increased customer demand for the quality of services provided, the industry has focused its attention on operational efficiency. To this end, insurance companies have taken a more holistic approach to strengthen their market position. One such approach is the Lean Management methodology. This methodology, through various tools and techniques associated with them, is capable of simplifying and optimizing processes, involving employees and managers, and increasing productivity levels, which consequently leads to the desired operational efficiency. This study analyzes how a Lean Management program was implemented in Insurer Company X, more specifically, in a work team belonging to the Operational Department, responsible for issuing and managing policies. The main objectives of the study are: to understand the motivation that led to the adoption of this philosophy, to list the main difficulties experienced during the adoption, to identify the lean tools and techniques used, as well as to identify the benefits and results of the Lean Management program at the level of processes. Through the documental/archive analysis and semi-structured interviews, the author concluded that lean's adoption was due to the decision of the Group to which the Insurer Company X belongs, and that resistance to change and not believing in the methodology were the main difficulties felt throughout the program. The main lean tools and techniques used were: SOP, Visual Management, CommCell, VoE and the 1-2-1 coaching. Finally, the program brought transparency in communication, processes, and productivity of team Y.info:eu-repo/semantics/publishedVersio

Função respiratória e funcionalidade do membro superior em pessoas com défice cognitivo ligeiro ou demência

Background: Cognitive decline is the main cause of disability and dependency in older people, leading to decreased lung function and ability to perform activities of daily living (ADL). However, in people with mild cognitive impairment (MCI) or dementia, little attention has been given to the assessment of respiratory function, and functional capacity studies have been focused on lower limb when upper limb plays a key role in ADL. Aim: To characterise the respiratory function and upper limb functionality of people with MCI or dementia. Methods: A quantitative, cross-sectional and exploratory study was conducted in people with MCI or dementia recruited in nursing homes, day care centres and long term care facilities. The sociodemographic, anthropometric and clinical data were collected with a structured questionnaire based on the checklist of the International Classification of Functioning, Disability and Health. The lung function (peak expiratory flow-PEF), respiratory muscle strength (maximal inspiratory, expiratory, and nasal inspiratory pressures-MIP/MEP/SNIP) and upper limb functionality (Grocery Shelving Task-GST) were assessed. Results: Sixty-one participants (62.7% ♀, 76.2±5.1 years) were recruited: 21 people with MCI/dementia institutionalised, 22 community-dwelling people with MCI/dementia, and 18 healthy older people. Lung function (PEF: 171.1±53.2 vs 266.5±82.5 vs 357.5±46.4 L/min, p <0.001), respiratory muscle strength (MIP [-25.9±-10.1 vs -41.7±-10.0 vs -90.9±-21.9 cmH2O; p<0.001], MEP [48.3±21.3 vs 69.9±20.2 vs 112.1±17.8 cmH2O; p<0.001] and SNIP [25.6±8.0 vs 45.3±23.2 vs 81.8±22.0 cmH2O; p<0.001); upper limb functionality (GST: 112.2±41.1 vs 69.4±34.2 vs 32.8±4.2 s; p <0.001) were significantly lower in people with MCI/dementia institutionalised than those community-dwelling and both groups presented lower values than healthy older people. Conclusion: Given the relevance of respiratory function and upper limb functionality to the quality of life of people with MCI or dementia, these results emphasize the need for routine evaluation of these parameters in these populations to develop personalized interventions as early as possibleEnquadramento: O declínio cognitivo é a principal causa de incapacidade e dependência em pessoas idosas, levando à diminuição da função pulmonar e da capacidade para realizar atividades de vida diária (AVD). Contudo, em pessoas com défice cognitivo ligeiro (DCL) ou demência, pouca atenção tem sido dada à avaliação da função respiratória e os estudos da capacidade funcional têm-se centrado no membro inferior, quando o membro superior desempenha um papel fundamental nas AVD. Objetivo: Caracterizar a função respiratória e a funcionalidade do membro superior em pessoas com DCL ou demência. Métodos: Foi realizado um estudo quantitativo, transversal e exploratório em pessoas com DCL ou demência recrutadas em estruturas residências para pessoas idosas, centros de dia e unidades de cuidados continuados. Foram recolhidos dados sociodemográficos, antropométricos e clínicos com um questionário estruturado baseado na checklist da Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Avaliou-se a função respiratória, (pico de fluxo expiratório–PEF), a força dos músculos respiratórios, (pressões inspiratória e expiratória máximas–PIM/PEM e inspiratória nasal-SNIP) e a funcionalidade do membro superior (Grocery Shelving Task-GST). Resultados: Foram recrutados 61 participantes (62.7%♀, 76.2±5.1 anos): 21 pessoas com DCL/demência institucionalizadas, 22 pessoas com DCL/demência a viver na comunidade, e 18 pessoas idosas saudáveis. A função pulmonar (PEF: 171.1±53.2 vs 266.5±82.5 vs 357.5±46.4 L/min; p<0.001), a força dos músculos respiratórios (PIM [-25.9±-10.1 vs -41.7±-10.0 vs -90.9±-21.9 cmH2O; p<0.001], PEM [48.3±21.3 vs 69.9±20.2 vs 112.1±17.8 cmH2O; p<0.001] e SNIP [25.6±8.0 vs 45.3±23.2 vs 81.8±22.0 cmH2O; p<0.001]), e a funcionalidade do membro superior (GST: 112.2±41.1 vs 69.4±34.2 vs 32.8±4.2 s; p<0.001) foram significativamente inferiores em pessoas com DCL/demência institucionalizadas relativamente às que vivem na comunidade e ambos os grupos apresentaram valores inferiores do que as pessoas idosas saudáveis. Conclusão: Dada a relevância da função respiratória e da funcionalidade do membro superior para a qualidade de vida das pessoas com DCL ou demência, estes resultados vêm enfatizar a necessidade da avaliação rotineira destes parâmetros nestas populações. de forma a serem desenvolvidas intervenções personalizadas o mais precocemente possívelMestrado em Fisioterapi